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Upper Extremity Firearm Injuries: Epidemiology and Factors Predicting Hospital Admission
Roy Toston, BS1, John T Hurt, BS2, Alex Dawes, BS3, Alexander R. Graf, MD4, Eric R. Wagner, MD2 and Michael Gottschalk, MD5, (1)Emory University School Medicine, Atlanta, GA, (2)Emory University, Atlanta, GA, (3)Emory University School of Medicine, Atlanta, GA, (4)Medical College of Wisconsin, Milwaukee, WI, (5)Orthopedic Surgery, Emory School of Medicine, Atlanta, GA

INTRODUCTION: Civilian gun violence is a public health crisis in the United States (US) with an economic burden reported to be as high as $17.7 billion with over half coming from US taxpayers' dollars through Medicaid related costs. The purpose of this study is to review the epidemiology of upper extremity firearm injuries in the US and the associated injury burden.
METHODS: The Inter-University Consortium for Political and Social Research's (ICPSR) Firearm Injury Surveillance Study database, collected from the National Electronic Injury Surveillance System (NEISS), was queried from 1993 to 2015. The following variables were reviewed, patient demographics, date of injury, diagnosis, injury location, firearm type (if provided), incident classification, and a descriptive narrative of the incident. We performed chi-square testing and complex descriptive statistics, and binomial logistic regression model to predict factors associated with hospital admission.
RESULTS: From 1993 to 2015 an estimated 314,369 (95%CI:291,528-337,750;16,883 unweighted) nonfatal firearm upper extremity injuries with an average incidence rate of 4.76 per 100,000 persons (SD:0.9;03.77-7.49) occurred. The demographics most afflicted with nonfatal gunshot wound injuries were black adolescent and young adult males (ages 15-24 years). Young adults aged 25-34 were the second largest estimate of injuries by age group. Hands were the most commonly injured upper extremity, (55,014;95%CI:75,973-89,667) followed by the shoulder, forearm, and upper arm. Patients who underwent amputation (OR:28.65; 95%CI:24.85-33.03) or with fractures (OR:26.20; 95%CI:23.27-29.50) experienced an increased likelihood for hospitalization. Patients with a shoulder injury were 5.5 times more likely to be hospitalized than those with a finger injury (OR:5.57; 95%CI:5.35-5.80).
DISCUSSION AND CONCLUSION: The incidence of upper extremity firearm injuries has remained steady over the last decade ranging between 4-5 injuries per 100,000 persons. Patients with proximal injuries or involved the bone were more likely to require hospital admission. This study should bring new information to the forefront for policy makers regarding gun violence.


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